Cognitive-behavioural interventions in cardiac rehabilitation.

Evidence pertaining to the efficacy of cognitive-behavioural interventions, broadly defined, in cardiac rehabilitation is reviewed. Primary concerns lie with risk reduction and with the amelioration of psychological distress following myocardial infarction. The available data permit few definitive conclusions. The available data, on balance, suggest that programmes targeted at reducing Type A behaviours, smoking cessation, increasing exercise, or which teach stress management techniques, may be effective in reducing psychological distress and increasing effective coping, although frequently only in the short-term; it is more difficult to point to long-lasting advantage in this context. In addition, psychological interventions of this sort would seem to be associated with positive behavioural change. However, there is, as yet, little concerted evidence that such changes afford benefits in terms of coronary heart disease mortality or morbidity. Nevertheless, the pessimism of these conclusions may reflect shortcomings in study design and the failure to optimally match patients to programmes rather than an intrinsic lack of efficacy of the interventions.